Family Application

*(denotes required field)

First Name: *

Last Name: *

E-Mail Address: *

Address 1:

Address 2:

City:

State:

Zip Code

Home Phone

Cell Phone

How do you prefer we contact you?:

Home Cell Email

How did you hear about us?

Marital Status

Spouse's Name

Expected Salary (Note: our Nannies earn between $11 and $16)

Looking For:

Full-Time Nanny Part-Time Nanny Occasional/Temporary Babysitter

When are you looking for your baby-sitter or nanny to start?

Do you mind if the nanny brings a child of her own?:

Yes No

Would you prefer a nanny with a child?:

Yes No

Please describe your childcare needs:

Describe any medical problems or allergies your children have

Family Setting

"Please describe your home(s) including quarters for Nanny:

Are there any pets in your home?:

Yes No

Is there a car available for the Nanny?:

Yes No

Will this position require travel?:

Yes No

What kind of travel?:

Occasional Regularly Almost Never

Is there any language other than English spoken in the home?:

Yes No

Are you currently pregnant?:

Yes No

Do you maintain a smoke free home?:

Yes No

Briefly describe the personality of you and your spouse:

What type of personality do you seek?

What type of responsibilities will be required? Please detail average hours per day, approximate start and ending times, days on duty, frequency of evening sitting, travel required, etc.:

What days and hours will the nanny work and what days will the nanny have off?

Do you employ domestic help such as a maid or cleaning service?:

Yes No

Will the family accept responsibility for taking reasonable care to protect the nanny from physical sexual emotional or psychological abuse by family members and or guests?:

Yes No

Comments or questions:

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